20050241A.pdf-A DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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PERMIT EXPIRES
PERMIT
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SUITE/APT#,
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCIP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required El
Street Use Ponnit Req'd [3
EXISTING PROPOSE[) Inspection Required
Sidewalk Required
Underground
REQUIRED DEDICATION— FT vyinng roquirao CI
METER SIZE LINE SIZE ]—N& OF IDITURES PRV REQUIRED
YES 13 NO
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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VARIANCE OR CU SHORELINE Oil ADB# I INSPECTION I BOND I
EXPIRATION D TE CHWKED BY POSTED
)TATE LICENSE NUMBER I REO'D I
ZERING REVIEWED DATE
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REVIEWED BY DATE
&33
6
OYES
2'NO
$
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
ROPERTY TAX ACCOUNT PARCEL NO.
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NEW
ADDITION
REMODEL
ESIDENTIAL
COMMERCIAL
MULTIFAMILY
PLUMBING MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
LOT COVERAGE
ALLOWED PROPOSED
2_
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
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PROPOSED SETBACKS (FT)
FRONT URSIDE REAR
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PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REPAIR
GRADING CYDS
FEN CE
( X FT)
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REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
CHECKED BY
TYPECYNSTRUCTION
I
CODE
OCCUPANT
GROUZZ.
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICA 11 &z;
AREAS
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NUMBERg-%
SPECIAL INSPECTION
REQUIRED [] YES
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
771
'�RIVJkA
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharg e
HEAT SOURCE
GLAZING %
I
LOT SLOPE %
Building Permit
A__2001)
City Surcharge
Plumbing
Base Fee
PLAN C=- X VESTED DATE
ey
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
uj PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
0 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFN� DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
HE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
Landscapelnsp.
Total Amt. Due
5?ql.,s
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
4�
0 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee
Receipt #
APPLICATION APPROVAL'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged In space provided.
LS SIGNSHE DATE
AORKMEN'S COMPENSATIgN INSURANCE AND RCW 18.27.
(425)
Sl ATUR!�(OWN ' 0 lb
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771-0220
DAfE
EMO 1333
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ATTENTION
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- uhiGINAL-FILE YELLOW- INPPFrTnR
PANCY HAS BEEN GRANTED. UBC109/iBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Front 2 2-5 CITY CUK A MAR. 0 2 2005
Date:
Sides, 7.5
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Rear 115 EXI5TINry GONG. G1.17
RETAININ& VqALL 15 NEV4 ADDITION
Other TO CON-NED'r
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NORTH PROPERTY LINE 210' oil
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SOUTH PROPERTY LINE 210' BUILDIN6 HE16HT GALGULATION
REGTAN6LE
W15WI-DINO HE16HT GALGULATION: IMPERVIOUS 5URFAGE GALGULATION:
E.
80 NORTHNEST bcl. 5 SHED (EXIST.) 112 DARIN SHELLEY.HA65TROM
NORTHEAST cl-1. 5 EXIST. HOUSE, 6ARA6E, DEGK5, PATIO:2,CiI2 21504 56TH PLA6E NEST
SOUTHEAST cib. 0 EXIST. DRIVE 4 NALK 5(93 EDMONDS, NA cIbO26
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5OUTHNE5T bcI. 5 PAVED SHARED ROAD: .1050
TOTAL 5-14.5 TOTAL EXIST. IMPERVIOUS SURFAGE5: 4,61 1 TAX A6GOUNT #: 0057560060160?
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r Ci3. Ib LOT AREA: -.-12'.X 210' 15,120 50. FT., ZONIN6: RS
AVERA6E
ALLONED: 25.0 EX15TIN6 % IMPERVIOUS 5URFAGE: 30.5%
5CALE: 20'
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r_ 30 51 TF. FLAN
LIMIT: Ilb.b REMOVED (NALK, DRIVE)
'a' EX15TIN6 R I 1?6E: 114.2 ADDED (6ARA6E, DRIVE, NALK, PORGH) 461 0 5 10 15 20
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E EX15TIN6 6ARA61E--� 105.5 PROP05ED TOTAL IMPERVIOUS 5URFAGE: 4,111 REV15ED 22 DEG 04 TGN
PROPOSED 6ARA6E: 103.3' PROPOSED % IMPERVIOUS SURFAGE: 31 .6% REVISED 25 FEB 05 TGN /2\
FINAL PROJECr r APPROVAL. FORM
TO:
DATE:
MEMO TO: PERMIT cbORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLFWSE SIGN
ENGINE
�Ef�ING DIVISION DATE 2
PLEASESIGN
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PLANNING DIVISION DATE
PIXASESIGN
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PROJECT
SITE ADDRESS 130�( �61 /_1
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PERMIT #, INSPECTED 2-12:.?L
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DESCRIPTION OF WORK TO BE INSPECTED x
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A field inspection was conducted to determine compliance with -approved plans. Final ap&oval
denotes that there are no objections from the above si*gned, Department to the release of
PERFORMANCE BONDS and. the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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copy of CONDITIONS. given to owner/con,tractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector.
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2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAII PROJECT APPROVAL.
Date Signature
1:temp:b1dg:fornis:ocaprv1 3/25/04